General advice

Why and how medicines are given with soft food or thickened fluid explains why thickened fluids are needed and how to find the recommended fluid thickness for a patient.

Alternatives to thickening liquid medicines

Getting the right fluid consistency (IDDSI Level) for the patient is difficult if you thicken a liquid medicine. This means that the patient may receive a liquid they cannot swallow safely.

Giving crushed tablets or opened capsules with food the patient can swallow is usually safer.

Choosing medicines formulations in swallowing difficulties provides advice on finding suitable options.

It may be necessary to thicken a small volume of medicine if a patient:

• needs a dose only achievable with a liquid medicine, and
• cannot safely swallow the liquid medicine in an un-thickened form

Thickening liquid medicines

Only thicken liquid medicines if there is no other suitable option. Consider switching to a different medicine.

If you need to thicken a liquid medicine:

• thicken one dose at a time, immediately before use
• check you have achieved the right consistency as best you can
• only give the medicine if you are confident the final product is the right consistency

Thickening small-volume medicines

Liquid medicines are usually given in doses 5 to 20ml. Instructions for thickeners are typically given for thickening 200ml of fluid. There are two possibilities for thickening individual doses of liquid medicines, both of which have risks:

Dilute the medicine dose, then thicken

Dilute the dose of medicine to 200ml and then thicken following the manufacturer’s directions for the thickener. The patient will need to drink 200ml to receive the full dose. This is unlikely to be acceptable to the patient, particularly if they take multiple medicines.

Thicken the medicine dose directly

To thickening individual small-volume doses directly, sprinkle the thickener onto the dose of medicine and stir. Wait a minute for the medicine to thicken, and then add more thickener if necessary.

Using this option, it is not possible to determine if the dose has been thickened to the appropriate IDDSI level. Consequently, this option is only suitable as a last resort.

Thickening large-volume medicines

Large-volume medicines include macrogol (polyethylene glycol (PEG)) laxatives such as Movicol and electrolyte replacement therapy such as Dioralyte. These are usually powders to be mixed with 125ml to 1 litre of water, depending on the indication. If these medicines are necessary, they will need thickening to the appropriate IDDSI level for the patient.

Do not use starch-based thickeners to thicken macrogol laxatives. Gum-based thickeners can be used. Thickeners and thickened fluids provides further information.

To thicken a large-volume medicine, dilute to 200ml (or measure 200ml of a larger volume) and follow the instructions for the thickener. Alternatively, follow local guidelines for thickening macrogol (PEG) laxatives if available.

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